By knowing the incidence of an infectious disease, we can ascertain the high risk factors of the disease as well as the e ectiveness of awareness programmes and treatment strategies. Since the work of Hugo Muench in 1934, many methods of estimating the force of infection have been developed, each with their own advantages and disadvantages. The objective of this thesis is to explore the di erent compartmental models of infectious diseases and establish and interpret the parameters associated with them. Seven models formulated to estimate the force of infection were discussed and applied to data obtained from CAPRISA. The data was agespeci c HIV prevalence data based on antenatal clinic attendees from the Vulindlela district in KwaZulu-Natal. The link between the survivor function, the prevalence and the force of infection was demonstrated and generalized linear model methodology was used i to estimate the force of infection. Parametric and nonparametric force of infection models were used to t the models to data from 2009 to 2010. The best tting model was determined and thereafter applied to data from 2002 to 2010. The occurring trends of HIV incidence and prevalence were then evaluated. It should be noted that the sample size for the year 2002 was considerably smaller than that of the following years. This resulted in slightly inaccurate estimates for the year 2002. Despite the general increase in HIV prevalence (from 54.07% in 2003 to 61.33% in 2010), the rate of new HIV infections was found to be decreasing. The results also showed that the age at which the force of infection peaked for each year increased from 16.5 years in 2003 to 18 years in 2010. Farrington's two parameter model for estimating the force of HIV infection was shown to be the most useful. The results obtained emphasised the importance of HIV awareness campaigns being targeted at the 15 to 19 year old age group. The results also suggest that using only prevalence as a measure of disease can be misleading and should rather be used in conjunction with incidence estimates to determine the success of intervention and control strategies. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.

In spite of the remarkable development of modern medical treatment and technology, the threat of pandemic diseases such as anthrax, cholera, and SARS has not disappeared. As a part of emerging healthcare decision problems, many researchers have studied how to detect and contain disease outbreaks, and our research is aligned with this trend. This thesis mainly consists of two parts: epidemic simulation modeling for effective intervention strategies and spatiotemporal monitoring for outbreak detection. We developed a stochastic epidemic simulation model of a pandemic influenza virus (H1N1) to test possible interventions within a structured population. The possible interventions — such as vaccination, antiviral treatment, household prophylaxis, school closure and social distancing — are investigated in a large number of scenarios, including delays in vaccine delivery and low and moderate efficacy of the vaccine. Since timely and accurate detection of a disease outbreak is crucial in terms of preparation for emergencies in healthcare and biosurveillance, we suggest two spatiotemporal monitoring charts, namely, the SMCUSUM and RMCUSUM charts, to detect increases in the rate or count of disease incidents. Our research includes convenient methods to approximate the control limits of the charts. An analytical control limit approximation method for the SMCUSUM chart performs well under certain conditions on the data distribution and monitoring range. Another control limit approximation method for the RMCUSUM chart provides robust performance to various monitoring range, spatial correlation structures, and data distributions without intensive modeling of the underlying process.

As you probably know, to board the B777-300ERi in Geneva for Anchorage via London, is not just that simple. With your ticket you bought several days before, you come to the airport, check in, pay airport's fees, go through the customs and security checks, walk in the terminal following signs, maybe you stop in the duty free shops, and finally find your gate. By this time, you are ready to board, about one hour after you enter the airport. / We will be essentially interested in air law that is why, the purpose of this master's thesis is to consider the legal aspect of facilitation in civil aviation. The term facilitation refers to the process that passengers, crew, luggage, cargo and mail have to go through when they cross borders to fly from a point A to a point B. / Recently, an aspect of facilitation took an outstanding importance: health issues. At the end of last year, the Severe Acute Respiratory Syndrome (SARS) outbreak was a real threat to international civil aviation because passengers (and crews) could have been exposed to an infected person inside the terminal or on board the plane, also, aircrafts were considered a fast vector of this disease through the world. The economic consequences for airlines and airports were very painful. / iBoeing 777-300 Extended Range.

Source: Dissertation Abstracts International, Volume: 70-07, Section: B, page: 4122. Adviser: John Michael Swint. Includes bibliographical references

Staphylococcus aureus remains an important pathogen, which, due to its capability to develop antimicrobial resistance, imposes an increasing threat to human health. Developing preventive means to decrease disease burden is a major aim. However, the development of an S. aureus vaccine, which would be one strategy to achieve such goals, has been complicated through limited understanding of the bacterium's pathogenic mechanisms. This work uses four approaches to address these limitations: Firstly, a reproducible RNA sequencing based method for the determination of gene transcription by S. aureus in vivo during mammalian infection. Secondly, examination of the impact of the bacterial transcription regulator 'Rsp' on the bacterium, which shows that mutations in this gene have profound functional and transcriptional impacts. Thirdly, by examining the in vivo transcription of multiple S. aureus strains during infection, proposing a 'core in vivo transcriptome' of induced genes under the conditions tested. Some of these genes are known to be involved in pathogenesis, others are not completely characterised and may represent suitable vaccine antigens. Finally, this work addresses limited understanding of S. aureus pathogenesis through defining transcriptional changes in vivo, which are induced by an altered immune response in immunised hosts. Together, this body of work contributes to the understanding of S. aureus pathogenesis and provides candidate antigens for future vaccine development.

The present study analyzed trends in communicable disease mortality in the State of Sergipe, Brazil over a period of 34 years. The purposes were to determine secular trends in mortality from these diseases, to identify age groups of greater mortality rates, and for SIDA, to determine incidence as well as mortality. It was an ecological study of time series and data were retrieved from the System of Information on Notifiable Diseases (SINAM) and System of Mortality Information (SIM) of the Health Agency of the State of Sergipe. The Joinpoint Regression Program of the National Cancer Institute, USA, performed trend analyses. The results we found showed that sepsis and gastroenteritis had greater mortality rates. The subset of Neglected Tropical Diseases (NTD) presented growing mortality trends, mainly schistosomiasis and Chagas’ disease; tuberculosis had growing trends only in males; and SIDA presented rising incidence and mortality trends in both genders, except in some age groups. It is imperative to implement new strategies in surveillance, treatment, and monitoring of specific diseases; to redesign SIDA control policies, particularly concerning to prevention, diagnosis, and care of the seropositive individuals. / Este estudo apresenta a análise da tendência de mortalidade por doenças infecciosas em um período de 34 anos no Estado de Sergipe. Os objetivos foram determinar a tendência secular de mortalidade por doenças infecciosas no Estado de Sergipe, identificar as de maior mortalidade, identificar as faixas etárias de maior ocorrência de mortalidade e determinar a incidência de AIDS no Estado de Sergipe. Trata-se de um estudo de séries temporais, parcialmente ecológico onde os cálculos de mortalidade foram realizados por meio de coleta de dados secundários obtidos do Sistema de Informação de Agravos de Notificação e do Sistema de Informação sobre Mortalidade da Secretaria de Saúde do Estado de Sergipe. As análises das tendências foram calculadas pelo Joinpoint Regression Program do National Cancer Institute, USA. Os resultados encontrados evidenciam que a sepsis e as gastroenterites apresentaram o maior número de óbitos por doenças infecciosas; as doenças tropicais negligenciadas apresentam crescimento na mortalidade, principalmente a esquistossomose, e a doença de Chagas; a tuberculose apresentou no gênero masculino tendência crescente e significativa de mortalidade e a AIDS apresentou tendências crescentes de incidência e da mortalidade em ambos os gêneros, com exceção de alguns grupos etários específicos. Faz-se necessário criar novas estratégias nos campos de vigilância epidemiológica, terapêutica e acompanhamento das doenças estudadas e rever as medidas de controle da AIDS, particularmente no tocante à prevenção, ao diagnóstico precoce e à assistência aos soropositivos do estado.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / As doenças infecto-parasitárias, ainda hoje, em pleno século XXI são responsáveis por uma quantidade generosa de morbidade e mortalidade no Brasil e no mundo. Muitas delas são amplamente influenciadas pelas mudanças climáticas que estão ocorrendo em todo o planeta fazendo com que sua incidência e distribuição geográfica aumentem. A dengue é considerada a principal doença reemergente nos países tropicais e subtropicais. A malária tem forte incidência nos países ao sul do deserto do Saara na África, ocorrendo também em vários países da América do Sul que possuem parte da região Amazônica em seu território. Várias doenças voltam a assolar a população de vários locais como as leishmanioses, a Doença de Lyme, erlichioses entre outras. Em março de 2009 começam a ocorrer os primeiros casos de uma nova doença inicialmente denominada Influenza suína, a qual, levou alguns indivíduos a óbito em Oaxaca, uma cidade mexicana localizada a 400 quilômetros da capital. Rapidamente, a doença se espalhou pelo país e posteriormente, no começo do mês de abril de 2009 já, existiam relatos de casos em vários países. O objetivo geral desta pesquisa é verificar em que medida o cuidado de enfermagem realizado expressou um maior ou menor grau de controle do enfermeiro sobre seu trabalho, apontando para os potenciais riscos (biológicos) de adoecimento e impactos negativos na saúde deste trabalhador. O presente estudo foi desenvolvido por meio de uma abordagem quantitativa com desenho longitudinal e observacional, delineamento de pesquisa não experimental e caráter descritivo. Foi feita a análise observacional nas tendas quanto a sua infraestrutura e posteriormente foi passado um questionário aos enfermeiros pautado em questões sobre o risco biológico que estes estavam sendo submetidos. Faz-se necessário que a cultura do improviso acabe e comece a se pensar em uma nova realidade: as doenças transmissíveis são uma realidade, elas existem e há de ser feito um adequamento de tudo que esteja ligado à área de saúde pensando em um novo contexto. É imperioso que tanto as autoridades como os profissionais revejam e reflitam sobre o que aconteceu, para que os erros do passado possam ficar para trás e não se repitam. / Infectious-parasitic diseases, up to the present, in XXI century are responsible for a high morbidity and mortality rate in Brazil as well as overseas. Many of them are widely influenced by climatic modifications that have been occuring all over the planet leading to an increase in their incidence and geographical distribution. Dengue is considered the main reemerging disease in tropical and subtropical countries. Malaria has strong incidence in countries that are in the south of Sahara desert in Africa, also occuring in many countries of South America that have part of their territory in Amazon region. A great deal of diseases have been frightening the population once again in many places, as leishmanioses, Lyme Disease, erlichioses, for instance. In March, 2009 the first cases of a new disease initially termed Influenza swine started to appear, leading some subjects to death in Oaxaca, a mexican city localized 400 kilometers far from the capital. Rapidly ,the disease had spread all over the country and later, in the beginning of April , 2009 there were some related cases in several countries. The overall aim of this study is to verify to what extent the nursing care that is carried out has expressed a higher or lower degree of control from the part of the nurse about his/her job, pointing at potential risks (biological) of illnesses and negative impacts into the worker health status. This study was developed by means of quantitative approach with longitudinal and observational design, a non experimental research and descriptive features. An observational analysis was carried out at the tents for their infra-structure and after this, a questionnaire was applied to the nurses based on matters as the biological risk they were being exposed. It is necessary that the improvisation culture comes to an end and a new reality come true : transmissible diseases are a reality, they exist and adjustments in relation to everything that is linked to health have to be achieved in order to envision a new context. It is essential that both authorities and professionals reflect and reconsider on the events from the past so as to old mistakes can be left behind and do not repeat again.

The present study analyzed trends in communicable disease mortality in the State of Sergipe, Brazil over a period of 34 years. The purposes were to determine secular trends in mortality from these diseases, to identify age groups of greater mortality rates, and for SIDA, to determine incidence as well as mortality. It was an ecological study of time series and data were retrieved from the System of Information on Notifiable Diseases (SINAM) and System of Mortality Information (SIM) of the Health Agency of the State of Sergipe. The Joinpoint Regression Program of the National Cancer Institute, USA, performed trend analyses. The results we found showed that sepsis and gastroenteritis had greater mortality rates. The subset of Neglected Tropical Diseases (NTD) presented growing mortality trends, mainly schistosomiasis and Chagas’ disease; tuberculosis had growing trends only in males; and SIDA presented rising incidence and mortality trends in both genders, except in some age groups. It is imperative to implement new strategies in surveillance, treatment, and monitoring of specific diseases; to redesign SIDA control policies, particularly concerning to prevention, diagnosis, and care of the seropositive individuals. / Este estudo apresenta a análise da tendência de mortalidade por doenças infecciosas em um período de 34 anos no Estado de Sergipe. Os objetivos foram determinar a tendência secular de mortalidade por doenças infecciosas no Estado de Sergipe, identificar as de maior mortalidade, identificar as faixas etárias de maior ocorrência de mortalidade e determinar a incidência de AIDS no Estado de Sergipe. Trata-se de um estudo de séries temporais, parcialmente ecológico onde os cálculos de mortalidade foram realizados por meio de coleta de dados secundários obtidos do Sistema de Informação de Agravos de Notificação e do Sistema de Informação sobre Mortalidade da Secretaria de Saúde do Estado de Sergipe. As análises das tendências foram calculadas pelo Joinpoint Regression Program do National Cancer Institute, USA. Os resultados encontrados evidenciam que a sepsis e as gastroenterites apresentaram o maior número de óbitos por doenças infecciosas; as doenças tropicais negligenciadas apresentam crescimento na mortalidade, principalmente a esquistossomose, e a doença de Chagas; a tuberculose apresentou no gênero masculino tendência crescente e significativa de mortalidade e a AIDS apresentou tendências crescentes de incidência e da mortalidade em ambos os gêneros, com exceção de alguns grupos etários específicos. Faz-se necessário criar novas estratégias nos campos de vigilância epidemiológica, terapêutica e acompanhamento das doenças estudadas e rever as medidas de controle da AIDS, particularmente no tocante à prevenção, ao diagnóstico precoce e à assistência aos soropositivos do estado.

Orientador: Luiz Jacintho da Silva / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T07:21:41Z (GMT). No. of bitstreams: 1 Kemp_Brigina_D.pdf: 3166494 bytes, checksum: 2892c145ef2c179f3d05514db4d4bc8b (MD5) Previous issue date: 2005 / Resumo: Em 2002, Campinas (São Paulo, Brasil) registrou a sua maior epidemia de dengue até então. O Sistema de Vigilância Epidemiológica Municipal recebeu cerca de 10 mil notificações de casos suspeitos de dengue. Mais de 70% dos casos foram descartados por critério laboratorial (MAC-ELISA). No pico da epidemia, na área de maior incidência, ocorreu um óbito em um indivíduo adulto. A suspeita inicial de dengue hemorrágico foi descartada depois de confirmada infecção por Rickettsia ssp, grupo da febre maculosa (Imunofluorescência indireta e PCR). Diante da grande proporção de casos não confirmados e da ocorrência de um óbito em razão da infecção por Rickettsia spp, duas hipóteses foram formuladas: a de uma epidemia, sobreposta ou a ocorrência de viés ou falha na confirmação laboratorial dos casos. Com o objetivo de avaliar essas hipóteses, a posteriori foram comparados os casos confirmados com os descartados, considerando o intervalo de tempo entre início dos sintomas e coleta de sorologia, de pacientes residentes no município, com data de início de sintomas de primeiro de janeiro até sete de outubro de 2002. A fonte foi o Sistema de Informação de Agravos de Notificação (SINAN). Os soros estocados, que resultaram negativos para dengue, foram novamente testados para dengue (MAC-ELISA, reagente comercial) e para riquetsiose dos grupos tifo e febre maculosa (imunofluorescência indireta). Os resultados obtidos das análises epidemiológicas e dos testes laboratoriais não permitiram esclarecer as questões iniciais. A hipótese de que haveria circulação de riquétsias do grupo tifo ou do grupo da febre maculosa não foi confirmada. A possibilidade de uma epidemia sobreposta, porém não pode ser descartada. Em oito por cento dos soros, inicialmente negativos para dengue, demonstrou-se a presença de anticorpos específicos, proporção não suficiente para aceitar a hipótese de inadequação do diagnóstico laboratorial. Fica evidente a necessidade de se implantar sistemas mais abrangentes de vigilância epidemiológica, quando se investigam agravos cujo diagnóstico diferencial é amplo, como no caso da dengue, sistemas que possam não só confirmar ou afastar o diagnóstico principal, como fazer o de outras infecções. Sistemas de vigilância sindrômica são particularmente indicados para esclarecer problemas dessa natureza.Outros elementos e ferramentas de trabalho devem ser agregados ao trabalho da vigilância, principalmente aqueles que possam ajudar as equipes específicas da área, também as de nível local, a ampliar e aprofundar o conhecimento dos problemas que afetam a saúde da população. A utilização de sistemas de informações geográficas e de outras metodologias que permitam trabalhar com áreas geográficas menores, possibilitando identificar diferentes riscos e adotar medidas mais direcionadas, podem ser auxiliares importantes para um controle mais efetivo dos problemas de saúde pública / Abstract: In 2002 the city of Campinas, SP, Brazil reported its greatest dengue epidemic. The Epidemiological Surveillance System received about 10,000 notifications of possible dengue cases. Over 70% of the cases were not confirmed by laboratory methods (MAC-ELISA, performed at the Instituto Adolfo Lutz, the state public health laboratory). During the peak of the outbreak, one adult died. The initially suspected diagnosis of dengue haemorrhagic fever was not confirmed, and a diagnosis of a spotted fever group rickettsiosis was confirmed by indirect immunofluorescent antibody assay and polymerase chain-reaction (PCR). Due to the high number of unconfirmed cases and the death by spotted-fever, two hypotheses were raised: either an overlapping, unsuspected epidemic or an inadequacy in the laboratory diagnosis. In order to clarify these issues, a posteriori of the epidemics, an epidemiological analysis was performed comparing the confirmed and unconfirmed cases, taking into consideration the time interval between the onset of symptoms and serologic investigation, among patients living in the municipality of Campinas who started having symptoms from January 1st through October 7th, 2002. The data source was SINAN-W, the national web-based data bank of notified diseases. Stored sera, negative for dengue fever, were tested again for dengue (MAC-ELISA, commercial reagent) and for rickettsial infection both typhus and spotted fever groups (indirect immunofluorescent antibody assay). Neither the epidemiological analysis nor the serological were able to suggest a parallel outbreak of rickettsial disease or that there had been an excessive amount of false-negative dengue tests. In only eight percent of the initially negative sera for dengue fever the presence of specific antibody was demonstrated, a proportion not sufficient to support the hypothesis of an inadequate laboratorial diagnosis. However, the possibility of an overlapping epidemic of an unknown nature could not be excluded. An explanation for the unconfirmed cases would be an over-zealous tendency to notify any fever as dengue during an epidemic.The need for more a more sensitive epidemiological surveillance system becomes obvious when investigating diseases with similar clinical symptoms, making an adequate differential diagnoses difficult. Syndrome-based surveillance systems are possibly better for situations such as these. It became obvious that current routine surveillance is not adequately sensitive and does not discriminate between all possibilities, leaving public health officials with a large amount of unanswered questions, like the one presently discussed. Other surveillance tools should be employed to increase the sensitivity of current methods. Geographical information systems should be introduced in the routine surveillance work. Current procedures are inadequate to cope with a dynamic epidemiological context, particularly when we regard the emerging infectious diseases / Doutorado / Epidemiologia / Doutor em Saude Coletiva

Orientador: Laércio Carvalho de Barros / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Matemática, Estatística e Computação Científica / Made available in DSpace on 2018-08-22T17:28:12Z (GMT). No. of bitstreams: 1 Simoes_FrancielleSantoPedro_M.pdf: 28047917 bytes, checksum: ca1168fc97ffd8570559d6deb4a5bb7a (MD5) Previous issue date: 2013 / Resumo: Neste trabalho estudamos sistemas de equações diferencias com parâmetros incertos e modelados por números fuzzy interativos através de duas abordagens distintas: a primeira via inclusão diferencial e a segunda via fuzzificação da solução determinística. Em ambos os casos a solução é fuzzy. Em seguida, a título de comparação, defuzzificamos a solução e a comparamos com a solução determinística. Notando que a operação produto é uma particular t-norma, propomos que a interação entre espécies (e/ou indivíduos) seja modelada por t-normas mais gerais. Neste caso, apesar da modelagem do sistema ser feita através de teoria de conjuntos fuzzy, as soluções dessas equações são determinísticas. A primeira abordagem é aplicada em um modelo para evolução de HIV positivo para populações em doença plenamente manifesta, enquanto a segunda é utilizada em modelos do tipo presa-predador de Lotka-Volterra e epidemiológico de transmissão direta / Abstract: We study systems of differential equations with uncertain parameters modelled by interactive fuzzy numbers. Two approaches are considered: differential inclusion and fuzzification of the deterministic solution. In both cases the result is a fuzzy solution. Next, we defuzzify the solution and compare with the deterministic one. Since the product operation is a t-norm, we propose interaction between species be modelled by more general t-norms. In this case, although modeling of the system is done using fuzzy set theory, the solutions of the equations are deterministic. The first approach was used to model the evolution of the positive HIV for populations with fully manifested disease, while the second was used in predator-prey models of Lotka-Volterra predator-prey type and in epidemiological models of direct transmission / Mestrado / Matematica Aplicada / Mestra em Matemática Aplicada